Cardiac pentastomiasis and tuberculosis: The worm-eaten heart

We report an autopsy case of disseminated tuberculosis and a coexisting, extremely rare parasitic zoonosis: pentastomiasis. The parasite was incidentally found in the pericardial sac and epicardium, associated with tuberculous pericarditis, in a 43-year-old woman from Georgia with presumptive Acquired Immunodeficiency Syndrome (AIDS). The cuticle was the only remaining intact structure of the parasite. The internal organs had undergone autolysis, but recognizable features were apparent. Gross and microscopic findings were highly suggestive of pentastomid species. The ultrastructure of the cuticle was consistent with a pentastomid arthropod. This is one of the few cases of visceral pentastomiasis reported in North America, and the first known example of heart involvement. The association of the parasitic infection and tuberculous pericarditis makes the case even more unusual.